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Form 9 UNION COUNTY, GEORGIA ALCOHOL LICENSING DEPARTMENT Consumption on the Premises Alcohol Sales Report (Reports are due January 30 and July 30 of each year) Reporting Period: January – June 20__ July – December 20__ BUSINESS NAME: County License # Address: State License # A. Gross Food Sales for reporting period $ B. Gross Alcohol Sales for reporting period + $ C. Gross Sales for reporting period = $ 1. For a business serving food, percentage of gross food sales A/C= % 2. For a business serving food, percentage of gross alcohol sales. B/C= % Alcohol Ordinance: 10-76 All licensed establishments shall submit to the county at least semi-annually, on or before January 30 and July 30 of each year, or as at such other times as requested, summaries of financial records showing compliance with the required percentage sales requirements, together with copies of back-up documentation, or the electronic equivalent if the county or Alcohol Board agrees. 10-77 Such eating establishment will regularly serve food every hour they are open and derive at least sixty percent (60%) of its gross receipts annually from the sale of prepared meals or food and derive no more than forty percent (40 from the sale of alcoholic beverages. 10-77 An eating establishment issued a license under this article shall be under a responsibility to demonstrate and provide regular proof that the business location for which the license is issued has gross sales from the sale of prepared meals or food of at least sixty percent (60%) of total gross sales of the business. I hereby certify that the statements made herein and in any supporting schedules are true, correct, and complete to the best of my knowledge. Printed Name Signature of Preparer Date Phone # Email Address